[Whipple's disease: typical cases and review].
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Actinobacteria↗
Biomedical subjects
B Wejda
Publications and source records attributed to B Wejda.
[Biliary ascariasis after cholecystectomy and papillotomy in a non-endemic area].
HISTORY AND ADMISSION FINDINGS: A 61-year-old woman was admitted to hospital with nausea and vomiting. Four years earlier she had undergone cholecystectomy and papillotomy. INVESTIGATIONS: Laboratory examination showed a slight increase of aspartate and alanine aminotransferase, glutamyl transpeptidase, and moderate eosinophilia. Ultrasound revealed an elongated echogenic structure within the common bile duct. At endoscopic cholangiopancreaticography (ERCP) a 23 cm-long Ascaris lumbricoides was found. TREATMENT AND COURSE: The worm was removed endoscopically with forceps. Antihelmintic therapy with mebendazole was given. After that the patient was well and laboratory findings were normal. CONCLUSION: Biliary ascariasis should also be considered in a non-endemic area. Previous cholecystectomy and papillotomy are predisposing factors. In our case ERCP was the diagnostic and therapeutic method of choice.
Animals↗
[Gastrointestinal stromal tumours (GIST) of the jejunum in a patient with neurofibromatosis type 1 (von Recklingshausen's disease)].
CASE REPORT: A 72-year-old female patient with known neurofibromatosis type 1 was admitted to the hospital with symptomatic anaemia and a history of melaena. Upper and lower endoscopy did not show any signs of bleeding. Ultrasound and computed tomography revealed an abdominal mass. The histological analysis of a US-guided puncture showed a mesenchymal tumour with spindle-shaped appearance. Laparotomy revealed two jejunal tumours which could be classified as gastrointestinal stromal tumours (GIST) by immunohistochemistry. CONCLUSION: Patients with neurofibromatosis type 1 have an increased risk of developing gastrointestinal tumours including rare types such as GIST. Because the localisation in the small intestine by conventional endoscopy can be difficult, further diagnostic means such as ultrasound, computed tomography or possibly capsule endoscopy should be considered.
Aged↗
[Skin-level gastrostomy -- long-term results from a prospective trial in gastric and jejunal application].
OBJECTIVE: The usefulness of skin-level gastrostomy tubes (button systems) for maintaining nutrition support after primary insertion of percutaneous endoscopic gastrostomy (PEG) is widely accepted. After first promising experiences with newly developed skin-level gastrostomy system (Freka-Button Gastrostomy) the safety and long-term stability of this new tube was not defined. MATERIAL AND METHODS: In a cohort study we prospectively evaluated from 2.1998 until 12.2001 for ease of use, complications, time to failure and long-term follow-up of 61 Freka button gastrostomies inserted in 50 patients (mean age 57.6 years, range 6 - 78 years, 44 men, 6 women). Mean time after primary PEG placement was 6.3 months (range 1 - 30 months). RESULTS: Correct application of all buttons (48 gastric, 2 jejunal) was easy and fast (median time 11 minutes) to perform. In 56 % we used a new Seldinger guide wire technique to improve stomal passage. Within the first ten days and during long-term follow-up (median 248, range 2 - 593 days) no major complication was seen. 11 systems had to be replaced mainly due to balloon failure (median 352, range 186 - 593 days). The total observation time were 15,128 days with a system failure rate of 0.26 per year. CONCLUSION: The Freka-button systems provides an easy-to-use, safe, and feasible alternative for long-term use of skin-level gastrostomy. First jejunal application of this new device was promising but needs further evaluation.
Adolescent↗
[Anaphylactic shock caused by rupture of an echinococcal cyst in a 25-year-old asylum seeker from Georgia].
HISTORY AND ADMISSION FINDINGS: A 25-year-old asylum seeker from Georgia was admitted to hospital with acute right upper quadrant abdominal pain, vertigo, dyspnea, generalized urticaria and positive shock index (blood pressure 80/40 mmHg, pulse 120/min) several minutes after eating an instant soup. INVESTIGATIONS: Laboratory investigations showed a slight increase of the eosinophilic cell count and GOT and GPT activities. Abdominal ultrasound scan (USS) and computed tomography (CT) revealed a multivesicular septated cystic space-occupying lesion of the right liver lobe (segment VII, 13 x 9 x 8 cm) and perihepatic fluid. TREATMENT AND COURSE: Intravenous steroids, H 1 and H 2 antagonists and fluid were given. Emergency laparatomy with endocystectomy was performed. A 3-month course of antihelmintic therapy with albendazole was applied. During follow-up up to one year after surgery the patient did well. Ultrasonography and computed tomography showed only a small residual defect in the right liver lobe where the cyst had been removed. CONCLUSION: In patients from echinococcosis-endemic regions who develop an anaphylactic reaction, a ruptured Echinococcus granulosus cyst should be considered in the differential diagnosis. Abdominal ultrasonography and serology (to be noted: substantial rate of false negative results!) should be performed.
Adult↗
[Successful use of a button system in "buried bumper" syndrome].
HISTORY AND CLINICAL FINDINGS: A 65-year-old patient had a fracture of the skull with resulting swallowing disorder and underwent percutaneous endoscopic gastrostomy (PEG) 9 months previously. A specific home care and maintenance of the PEG was not provided. The patient was referred to our hospital because of haematemesis on the suspicion of upper gastrointestinal bleeding. He was in a generally reduced condition with the clinical signs of anaemia and with a positive shock index. INVESTIGATIONS: The laboratory tests revealed an anaemia. The gastroscopy showed an active bleeding ulcer under the migrated internal bumper of the PEG (buried bumper syndrome). The bleeding activity was classified as Forrest lb. In addition, the chest X-ray and the bronchoscopy showed bilateral pneumonia. DIAGNOSIS, TREATMENT AND COURSE: Summarizing the diagnoses there was an active bleeding ulcer in the sense of a buried bumper syndrome in combination with bilateral pneumonia caused by aspiration. After releasing the bumper the bleeding was stopped by local injection therapy. As additional treatment of the lesion it was aimed to lower pressure on the affected mucosal area. This was achieved by the use of a button gastrostomy with a liquid-filled retention balloon that was placed through the preexisting stoma. The pneumonia was treated with antibiotics. Follow-up gastroscopies revealed good healing of the ulcer and the patient was discharged. CONCLUSIONS: The complication of a buried bumper syndrome with ulcer bleeding can effectively be treated by the use of a button gastrostomy. Treatment is based on sufficient pressure relief in the affected mucosa area. Advantages can be seen in the maintenance of the stoma and in the opportunity for an early continuation of enteral feeding.
Aged↗
Hip fractures and the thyroid: a case-control study.
OBJECTIVE: To investigate the prevalence of thyroid illness - especially hyperthyroidism - and exposure to thyroid hormones in patients with hip fracture. DESIGN: A case-control study. SETTING: Two surgical/orthopaedic hospital units and 22 facilities for the aged in a moderately iodine-deficient region of Germany. SUBJECTS: A total of 116 postmenopausal females with hip fracture and 402 postmenopausal female controls. MAIN OUTCOME MEASURES: Hip fracture; thyroid disease confirmed by measurement of serum thyrotropin, total and free thyroxine and triiodothyronine; history of thyroid disease and thyroid medication obtained by a questionnaire. RESULTS: Of the hip fracture patients 4.3% had overt untreated hyperthyroidism, and 6.9% gave a history of past hyperthyroidism (total, 11.2%). The corresponding figures for the controls were 2.0 and 2.7%, respectively (total, 4.7%). 7.8% of the cases had been exposed to levo-thyroxine for 3-29 years, compared to 11.2% of the controls. The odds ratio for hyperthyroidism (present and past) was 2.5 (1.2-5.3, 95% confidence interval), and the odds ratio for levo-thyroxine exposure was 0.67 (0.32-1.41) in the hip fracture patients. CONCLUSIONS: Hyperthyroidism is found 2.5-fold more often in hip fracture patients than in controls. Hence, hyperthyroidism appears to be a significant risk factor for hip fracture and should be investigated by clinical and, when necessary, laboratory means in hip fracture patients. In contrast, no increased risk for hip fracture could be detected after exposure to levothyroxine.
Aged↗